Types, Symptoms, Treatment, and More

Types, Symptoms, Treatment, and More

A sessile polyp is a flat, broad growth of abnormal tissue that develops on the lining (mucosa) of the large intestine, which includes the colon and rectum. Sessile polyps are often asymptomatic, meaning they cause no symptoms. Most are discovered during routine colorectal cancer screening tests, such as a colonoscopy.  

While most sessile polyps are benign (noncancerous), some types have the potential to become cancerous over time. Treatment for sessile polyps depends on the size, type, and number of polyps found.

Between 15-40% of adults in the United States have colon polyps, which are most common in people aged 45 or older. While only a small percentage of all colon polyps become cancerous, certain types of sessile polyps account for up to 30% of colorectal cancers.

There are several types of sessile polyps, which are classified based on their growth patterns. Healthcare providers can identify sessile polyp types when viewing a sample of the polyp tissue under a microscope.

Identifying the type of sessile polyp a person has helps determine its potential for becoming cancerous (malignant), allowing healthcare providers to assess the cancer risk and make appropriate treatment decisions.

Types of sessile polyps include:

  • Sessile serrated adenomas: These polyps have saw-toothed edges when viewed under a microscope. They are precancerous and require prompt removal because they have the potential to progress to colorectal cancer.
  • Tubular adenomas: While these polyps can grow from the intestinal lining in a way that resembles a mushroom and its stalk, they can also be flat. Small, tube-shaped polyps are usually benign, but larger ones are more likely to contain cancer cells.
  • Villous adenomas: Under a microscope, these flat polyps have a shaggy cauliflower-like or finger-like appearance. Compared to other polyp types, they are often larger. They are also more likely to contain cancer cells and require prompt removal.
  • Tubulovollous adenomas: Tubulovollous adenoma polyps have a combination of tubular and shaggy growth patterns. Compared to tubular adenomas, these polyps generally have a higher risk of becoming cancerous, especially when they are larger than half an inch. 

Sessile polyps typically do not cause symptoms. Larger sessile polyps may bleed and lead to symptoms such as:

  • Bloody stool: Blood in your stool (poop) may appear bright red or black, depending on where the bleed is in your colon or rectum. 
  • Rectal bleeding: Blood on the toilet paper or in the toilet bowl after a bowel movement or blood on your underwear are signs of rectal bleeding. 
  • FatigueBlood loss can cause anemia (fewer red blood cells than usual), which leads to fatigue. 
  • Changes in bowel habits: You may have fewer or more frequent bowel movements than usual.
  • Abdominal pain: Although uncommon, some people may experience abdominal (belly) pain. 

Symptoms of sessile polyps are vague and similar to symptoms of many gastrointestinal conditions, so it’s important to see a healthcare provider to determine the cause, especially if you experience bloody stool or rectal bleeding. 

It’s unknown what causes sessile polyps to form in the lining of the colon and rectum, though research suggests genetic and environmental factors likely play a role. Genetic mutations that are inherited (passed down) or acquired (developed due to environmental factors) can lead to uncontrolled cell growth, contributing to polyp development.

Inherited genetic mutations can cause a rare hereditary syndrome known as familial adenomatous polyposis. This causes hundreds or thousands of polyps to grow in your colon.

Meanwhile, some environmental factors, such as exposure to certain chemicals, can damage cellular DNA and lead to acquired gene mutations that may contribute to polyp development.

Risk Factors

Anyone can develop sessile polyps, but certain factors can increase your risk, including:

  • Age: Polyps are more common in people aged 45 years or older. 
  • Family history: Having someone in your family with a history of polyps or colorectal cancer can make it more likely that you will develop polyps. 
  • Underlying conditions: Inflammatory bowel disease (IBD), such as ulcerative colitis (UC) and Crohn’s disease, can increase your risk of developing polyps. 
  • Diet: A diet low in fiber and high in red meats may contribute to polyp formation.
  • Lifestyle habits: Smoking and excessive alcohol consumption are known risk factors for developing colon polyps.

Most people learn they have one or more sessile polyps during routine colorectal cancer screenings. Your healthcare provider may order screening tests to detect and diagnose sessile polyps if you have concerning symptoms, such as bloody stool, or have a family history or underlying condition that increases your risk of colon polyps. 

Tests and procedures for diagnosing sessile polyps include: 

  • Colonoscopy: A flexible tube with a tiny camera (colonoscope) is inserted into the anus to view the colon and rectum and identify abnormalities, such as inflammation or polyps. Your healthcare provider may take a biopsy (small tissue sample) from a sessile polyp and examine it under a microscope to determine whether it contains cancer cells.
  • Flexible sigmoidoscopy: This procedure involves inserting a flexible tube equipped with a light and camera (sigmoidoscope) into the anus to help visualize your rectum and sigmoid colon (lower colon). If your healthcare provider spots a polyp, they may take a biopsy and send it to the lab to test for cancer cells.
  • Virtual colonoscopy: Also known as a computed tomography (CT) colonoscopy, a virtual colonoscopy involves taking X-ray photos of your colon and rectum and using a computer to create detailed images and identify polyps and other abnormalities.
  • Lower gastrointestinal (GI) series: Also known as a barium enema, this X-ray examination involves filling the colon with a contrast material (barium) to highlight and identify polyps and other abnormalities on X-ray images.

The goal of treating sessile polyps is to remove them so they can’t turn into colorectal cancer. How they’re removed varies depending on the size, type, and number of sessile polyps detected during the imaging procedures. Treatment of sessile polyps can include:

  • Removal during colonoscopy or sigmoidoscopy: In many cases, healthcare providers can remove sessile polyps during a colonoscopy or sigmoidoscopy using instruments to cut, cauterize (burn), or ablate (destroy) the abnormal tissues. 
  • Endoscopic mucosal resection (EMR): Healthcare providers may use EMR to remove larger sessile polyps. EMR involves suctioning abnormal tissues or injecting a solution beneath the polyp to lift it from the surrounding tissue, followed by removal with surgical tools.
  • Surgery: In some cases, surgery may be necessary to remove a large sessile polyp or one that is difficult to reach with the endoscope.

After polyp removal, you will need regular follow-up colonoscopies or other screening tests to monitor for new polyps. How often your healthcare provider recommends follow-up screening tests will depend on your risk factors and the type of sessile polyp removed.

There is no guaranteed way to prevent sessile polyps, but healthful lifestyle habits may lower your risk. These habits can include the following:

  • Focus on a balanced diet: Maintaining a diet rich in fruits, vegetables, and whole grains while limiting red meat and processed foods may protect against sessile polyps. 
  • Manage your weight: Obesity is a risk factor for colon polyps. Maintaining whatever weight you and your healthcare provider discussed by exercising regularly and eating a nutritious diet may lower your risk. 
  • Limit alcohol: Avoiding or limiting your alcohol intake can help protect against colon polyps. 
  • Avoid smoking: Smoking increases the risk of colon polyps; quitting can help lower your risk and protect your overall health.

Whether or not a sessile polyp is cancerous, there could be complications if you do not address it. Undiagnosed and untreated sessile polyps can increase your risk of: 

  • Colorectal cancer: Some types of sessile polyps can progress into colorectal cancer when abnormal (cancerous) cells within the polyps continue to grow and multiply, forming a tumor.
  • Anemia: Chronic bleeding in the colon or rectum from sessile polyps can cause blood loss and lead to iron deficiency anemia, which occurs when the body doesn’t have enough iron to make red blood cells. Symptoms include fatigue, headaches, weakness, and heart palpitations.
  • Intestinal blockage: Large polyps in the colon can block the passage of stool through the colon and rectum, leading to symptoms such as abdominal pain, bloating, constipation, or the inability to pass gas or stool. 

Sessile polyps are flat growths that develop on the lining of the colon and rectum. While most sessile polyps are benign (noncancerous), some can become malignant (cancerous). Most people with sessile polyps do not have symptoms, though some sessile polyps can cause bloody stool, rectal bleeding, or abdominal pain.

Healthcare providers diagnose sessile polyps using imaging tests like colonoscopy and flexible sigmoidoscopy. Removal of the sessile polyp is required to lower the risk of colorectal cancer, and regular follow-up screening tests are important for detecting new polyps.

While there is no guaranteed way to prevent sessile polyps, mindful lifestyle habits such as eating a balanced diet and quitting smoking can help lower your risk. Talk to a healthcare provider about screening tests if you have a family history of colon polyps or colorectal cancer or develop concerning symptoms, such as bloody stool. 

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